Safety and Efficacy of Radiofrequency Ablation of the Medial Branch Nerves with Preexisting Spinal Hardware. A Case Series and Review of Literature

Abstract

Purpose of Review

To explore the efficacy of radio frequency ablation in treating pain in patients with hardware at site of the procedure.

Recent Findings

There is very limited data in literature about this topic. One study performed in 2016 indicated no complications when performing RFA close to hardware in patients with chronic pain conditions.

Summary

Radiofrequency ablation can be safely and effectively performed close to hardware. While heating of the hardware can happen which can theoretically lead to tissue injury or decreased heat going to target nerve, this does not seem to be of clinical significance. More studies are needed to confirm this finding.

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Unique Considerations for Special Populations in Episodic Migraine: the Underserved

Abstract

Purpose of Review

People with migraine disease face many challenges, and these challenges can be magnified when someone is part of an "underserved" population. We set out to examine various categories of "underserved" populations, consider the unique challenges faced by these groups, and discuss mechanisms to mitigate these challenges as much as possible.

Recent Findings

Very little research has been performed to specifically evaluate underserved populations related to people with migraine disease. Recent research has shown the overall limitations of limited numbers of physicians with specialty training in headache disorders, and the socioeconomic implications of migraine disease have long been reported.

Summary

Even the definition of "underserved" is not completely clear. We undertook to define this concept in the setting of migraine disease, breaking into different categories, including financial, geographic, and cultural/racial. Each underserved population has both shared and unique challenges, and in reality, given the paucity of medical expertise throughout the United States, one could make the argument that nearly all people with migraine disease are at risk for being underserved. In the future, epidemiologic as well as therapeutic research should incorporate analyses of these and any other underserved population to improve the application of study results across broad and varied populations whose commonality, in many cases, ends with sharing the same disease.

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Geographical Differences in Trigger Factors of Tension-Type Headaches and Migraines

Abstract

In this review, we discussed the types and frequencies of trigger factors of primary headache [migraine and tension-type headache (TTH)] among adult patients. We assessed the influence of geographical location, ethnicity and gender on the various trigger factors of a migraine and a TTH. We also evaluated the trigger factors among the multi-ethnic Southeast Asian adult patients. In a recent study, odor triggered more migrainous headaches compared to the other primary headaches. Odor was observed to be specific of migraines. Moreover, stress is one of the most common trigger factors for patients with migraines and TTHs worldwide. Migrainous patients have an increased sensitivity in comparison to non-migrainous patients. Furthermore, these patients have much difficulty in adapting to the high level of sensitivity, and the sensitized brain is therefore more vulnerable to trigger factors. In addition, the presence of one trigger factor may increase the exposure of other trigger factors. This phenomenon is more marked in the patients with migraines who have stress and menstruation as triggers, predisposing them to be more sensitive to other triggers. In conclusion, the geographical location factor has an influence on the trigger factors of headaches. Ethnicity may have an effect due to the cultural differences. Change in weather and sunlight are important commonly identified trigger factors for headaches. Moreover, gender differences in some trigger factors are present among the patients with headaches, especially sunlight and sleep deprivation. More research studies can be conducted to have a better understanding on trigger factors in the future. This will enable proper identification of trigger factors, leading to a decrease in the number of headache episodes and an improvement in quality of life for patients.

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Complementary and Integrative Medicine for Episodic Migraine: an Update of Evidence from the Last 3 Years

Abstract

Purpose of Review

The purpose of this review is to evaluate evidence from the last 3 years on complementary and integrative medicine treatment options for episodic migraine. Using Pubmed, Embase, and Cochrane databases, research published from 2015-2018 evaluating the modalities of mind/body therapies, supplements, and manual therapies for treatment of migraine were assessed.

Recent Findings

Although many studies had major methodological challenges that limit interpretation, several studies reported decreased headache frequency, improved quality of life, or less affective responses to pain. The evidence is currently most promising for the mind/body treatment options of mindfulness, yoga, and tai chi. Mindfulness meditation may be as effective as pharmacological treatment for medication-overuse headache after the offending medication is withdrawn. While older research has shown magnesium, riboflavin, feverfew, and butterbur to be helpful in migraine treatment, new research is promising to suggest potential benefit with melatonin, vitamin D, higher dosages of vitamin B₆ (80 mg)/folic acid 5 mg combinations, and the combination of magnesium 112.5 mg/CoQ10 100 mg/feverfew 100 mg. Omega 3s have limited evidence of efficacy in migraine. Butterbur needs to be free of pyrrolizidine alkaloids (PA) to ensure safety given their hepatotoxicity. Physical therapy (PT) continues to have strong evidence of support, and acupuncture is superior to sham acupuncture and placebo. Side effects and risks reported were minimal and well tolerated overall, with the exception of the life-threatening risk of cervical artery dissection with high-velocity chiropractic manipulation and hepatotoxicity with the PAs in butterbur. Several studies are ongoing to further evaluate mindfulness, melatonin, PT, exercise, chiropractic manipulation, and acupuncture. The American Academy of Neurology (AAN) and American Headache Society (AHS) are currently updating the guidelines for integrative treatment options for migraine, so additional recommendations may be available soon.

Summary

In conclusion, many complementary and integrative treatment options may be helpful for patients with migraines, and understanding potential efficacy, benefits, and risks can help providers discuss these modalities with their patients. Such a conversation can empower patients, build the therapeutic relationship, and increase self-efficacy, thus improving outcomes and patient-centered care.

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Cutaneous findings in Bardet‐Biedl syndrome

Abstract

Background

Bardet‐Biedl syndrome (BBS) is a rare, pleiotropic syndrome and member of a diverse group of disorders known as ciliopathies. Improved understanding of dermatoses in BBS will further understanding of the syndrome and will help define the role of dermatologists in providing care for patients with BBS. The purpose of this study was to describe the cutaneous phenotype of BBS in patients attending a large, multispecialty BBS clinic.

Methods

All patients attending the multispecialty BBS Clinic at the Marshfield Medical Center over a 12‐month period were invited to participate. Complete cutaneous examinations were performed by a board‐certified dermatologist, and comprehensive physical examinations were performed by clinic physicians. Molecular genetic results were obtained when available. Comprehensive laboratory studies were performed in each patient including fasting blood sugar and thyroid and renal function.

Results

Thirty‐one individuals ranging in age between 2 and 69 years (median age, 12 years) participated in the study. Cutaneous findings were present in all subjects. Keratosis pilaris was present in 80.6% of subjects, and seborrheic dermatitis was present in 19.3%. Obesity, a cardinal feature of BBS, was present in the majority of subjects (90.3%) and was accompanied by known obesity‐related dermatologic disorders.

Conclusions

Cutaneous disorders are common in BBS and suggest disturbance of keratinization and keratinocyte function as well as systemic consequences of BBS on skin health. Increased prevalence of skin barrier dysfunction in this ciliopathy demonstrates the importance of dermatologist contribution to health care in BBS.

https://ift.tt/2U0Wy91

Acute vertigo presenting with spontaneous horizontal nystagmus (SHN),Isolated hypofunction of a horizontal semicircular canal (HSC)

Isolated horizontal canal hypofunction differentiating a canalith jam from an acute peripheral vestibular loss

Publication date: March–April 2019

Source: American Journal of Otolaryngology, Volume 40, Issue 2

Author(s): Andrea Castellucci, Pasquale Malara, Cristina Brandolini, Valeria Del Vecchio, Davide Giordano, Angelo Ghidini, Gian Gaetano Ferri, Antonio Pirodda

Abstract

Objectives

To describe a unique case of acute vertigo presenting with spontaneous horizontal nystagmus (SHN) and a clinical picture consistent with right acute peripheral vestibular loss (APVL) in which an isolated hypofunction of a horizontal semicircular canal (HSC) permitted to detect a spontaneous canalith jam and treat the patient accordingly.

Methods

Case report and literature review.

Results

A 74-year old woman presented with acute vertigo, left-beating SHN and a clinical picture consistent with right APVL. Nevertheless, vestibular evoked myogenic potentials were normal with symmetrical amplitudes and the video head impulse test (vHIT) revealed an isolated hypofunction of the right HSC. After repeated head shakings, the supine roll test evoked bilaterally a positioning paroxysmal geotropic horizontal nystagmus suggesting benign paroxysmal positional vertigo involving the non-ampullated arm of the right HSC. vHIT and caloric testing confirmed restitution of HSC function after repositioning maneuvers.

Conclusions

In case of acute vertigo with SHN, a complete functional assessment of vestibular receptors and afferents should always be given in order to avoid misdiagnosis. Canalith jam should be considered in case of spontaneous nystagmus and isolated canal hypofunction.

Indocyanine green in the parathyroid detection and protection

Application of indocyanine green in the parathyroid detection and protection: Report of 3 cases

Publication date: March–April 2019

Source: American Journal of Otolaryngology, Volume 40, Issue 2

Author(s): Hao Jin, Jinrui Fan, Jun Yang, Kun Liao, Zhuocheng He, Min Cui

Abstract

Background

It was thought that identifying the parathyroid gland during surgery was difficult for surgeons. It may be critical to locate the parathyroid for surgeons during thyroidectomy or parathyroidectomy due to the significant function of the parathyroid in calcium balance. According to recent reports, intrinsic fluorescence of the parathyroid has been found. There is some evidence to suggest that new equipment can detect the intrinsic fluorescence via imaging technology. In this case reports, a newly-invented intraoperative fluorescence imaging system and indocyanine green dye were applied to detect the parathyroid gland and evaluate the vascularization of parathyroid.

Case presentation

From July 1st to August 8st, 2018, 3 patients underwent total thyroidectomy in Zhuhai People's Hospital. The 3 subjects were recruited into our research. Indocyanine green angiography was performed on all the three participants. By ICG angiography, parathyroid glands were identified and protected. In the 3 patients, postoperative PTH levels were in the normal range. No one of them developed transient hypoparathyroidism.

Conclusions

This study has identified that the fluorescence imaging system applied with indocyanine green is a safe, easy and effective method to protect the parathyroid and predict postoperative parathyroidism.